Abstract
Longitudinal analyses of opioid use and overall disease severity among people with HIV (PWH) are lacking. We used joint-trajectory and Cox proportional hazard modeling to examine the relationship between self-reported opioid use and the Veterans Aging Cohort Study (VACS) Index 2.0, a validated measure of disease severity and mortality, among PWH engaged in care. Using data from 2002 and 2018, trajectory modeling classified 20% of 3658 PWH in low (i.e., lower risk of mortality), 40% in moderate, 28% in high, and 12% in extremely high VACS Index trajectories. Compared to those with moderate VACS Index trajectory, PWH with an extremely high trajectory were more likely to have high, then de-escalating opioid use (adjusted odds ratio [AOR], 95% confidence interval [CI] 5·17 [3·19–8·37]) versus stable, infrequent use. PWH who report high frequency opioid use have increased disease severity and mortality risk over time, even when frequency of opioid use de-escalates.
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Acknowledgements
We would like to acknowledge the veterans who participate in the Veterans Aging Cohort Study (VACS) and the study coordinators and staff at each VACS site and at the West Haven Coordinating Center. We would also like to thank Dr. Bobby Jones for his assistance with the joint-trajectory modeling procedures. The authors declare that they have no conflict of interest. This work was supported by supported by the National Institute on Drug Abuse (5R01DA040471-03), National Institute on Alcohol Abuse and Alcoholism (U10-AA13566), National Institute of Mental Health (F31-MH114736-01A1), and National Institute of Allergy and Infectious Diseases (T32-AI052074).
Funding
This work was supported by the National Institute on Drug Abuse (5R01DA040471-03, R25-DA037190), National Institute on Alcohol Abuse and Alcoholism (U10-AA13566), National Institute of Mental Health (F31-MH114736-01A1), and National Institute of Allergy and Infectious Diseases (T32-AI052074).
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JWA, YL, BDLM, and EJE conceptualized this specific analysis. YL performed the formal analysis. JWA and EJE wrote the resulting manuscript while YL, DTB, KSG, RDK, BO, CTR, and BDLM provided feedback and edits. All authors reviewed and approved submission.
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Adams, J.W., Li, Y., Barry, D.T. et al. Long-term Patterns of Self-reported Opioid Use, VACS Index, and Mortality Among People with HIV Engaged in Care. AIDS Behav 25, 2951–2962 (2021). https://doi.org/10.1007/s10461-021-03162-7
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DOI: https://doi.org/10.1007/s10461-021-03162-7